Ask the Expert

The purpose of VACPG’s Ask the Expert series is to get information from point A (the expert) to point B (you!) quickly and easily. There will be a new Ask the Expert series once a season. If you want to be notified as soon as a new presentation is released, please sign up to be part of the VACPG listserv.

Winter 2017-2018

Jennifer Barnes, LPC

Bio:I am a Licensed Professional Counselor (LPC) in Virginia and a Licensed Clinical Professional Counselor (LCPC) in Maryland. In 2007, I received my Master’s in Mental Health Counseling from Gallaudet University. Psychology was my undergraduate major at the University of Central Florida. I have been practicing now for over 10 years in behavioral health. Empowering individuals and getting a person on the path towards self-advocacy is my passion in counseling. I believe in an accepting, non-judgmental approach to meet individuals where they are in their journey through life.

What do you think of gambling disorder being added to the DSM V? Adding problem gambling to the DSM V under its own category was a wise choice. Gambling Disorder is different from any other form of addiction and should be treated as such. With Problem Gambling allotted with its own category leads to the necessary distinctive approach and treatment.

How long have you worked with folks experiencing problem gambling or gambling disorder?After taking a training course from in October 2015, I officially started working with individuals with problem gambling in September 2016. I have been working with individuals for about 2 years now.

What do you enjoy about working this capacity with people challenging their gambling disorder/addiction?Because I take a harm reduction approach using Motivation Interviewing, I enjoy the collaboration that occurs during sessions. It is a team-based approach with the Client leading the way. I feel that this approach is helpful in allowing the Client to gain insight towards behavior and thought patterns, thus guiding them to acknowledging and setting their own boundaries around gambling. Motivational interviewing provides a Client with the tools necessary to manage choices and steers them towards self-empowerment.

I am particularly excited to see that you work with people who are D/deaf and Hard of Hearing (HoH). How does hearing status interact with current assessments, intervention, and even just seeking help?Several factors need to be considered when working with the Deaf/HoH population. The primary issue is communication. In most situations, Sign Language is necessary to break down barriers related to communication. However, I think it is also important to understand that every individual is unique and therefore each person’s communication needs can be different. The most important rule I try to follow when working with this population is to assume nothing. It is vital to ask questions and clarify communication needs. Given that many assessments are typically hearing based, a professional working with the Deaf population should keep this under consideration. In regards to interventions, it is important to remember that access in a hearing world isn’t always equal for one who is Deaf/HoH. There can be additional obstacles for accessing resources that a professional may recommend. For example, referring a Client to Gambling Anonymous can become an added frustration due to communication barrier. In general, seeking mental health services is a challenge for this community. Even with the use of an interpreter, there is a financial weight involved and addressing who will cover the cost (provider or Client) can become an additional barrier to receiving mental health services.

Have you found assessment instruments that you utilize, which meet a person’s needs with improved diagnostic outcome?Usually, I find a general psychosocial assessment along with a mental status exam sufficient for diagnosing individuals. If I experience an individual struggling with describing their presenting issues or symptoms, I may administer an additional assessment such as the Beck Depression Inventory or The Mood Disorder Questionnaire. The Mood Disorder Questionnaire has been very helpful in diagnosing Bi-Polar Disorder with more accuracy. In regards to assessments for problem gambling, I keep the NODS-Clip, NODS-PERC, Brief Bio-Social Gambling screening (BBGS) and Lie-Bet questionnaire’s in my tool kit. I choose which to use depending on my level of certainty in the diagnosis as well as what information the Client provides. In addition to this, I have the SOGS (South Oaks Gambling Screen) which I feel is used more for an individual that is uncertain of having a gambling problem, but I suspect there may be an issue.

Within a person-centered approach, do you particularly find one intervention or treatment that is best practice? In general, my approach is depends on the Client. Depending on the person’s level of understanding and where they are on their own journey is how I meet them. I tend to utilize a strength-based approach to assess a person’s strong points that will help them overcome obstacles in their life. Motivational interviewing and Psychodynamic are modalities that I tend to use often. Due to my experience of working with individuals who may be intellectually challenged, I tend to focus on behavior. Therefore, I will use CBT or some derivative of CBT. During my undergrad years, I interned with an applied behavior analysis agency for over a year. This helped me develop skill with Behavioral Therapy.In regards to working with individuals who struggle with problem gambling, my primary approach is motivational interviewing as stated above.

What would be a recommendation to share with other providers seeking insight to providing care or intervention to people with a gambling disorder/addiction?First and foremost is assessing for gambling issues. Prior to taking my training, I did not ask people about gambling or talk about gambling. It wasn’t even part of the intake form. I have come to find out that most practices are not assessing for problem gambling. In addition to this, the general public thinks of a gambling disorder/addiction is defined as a person that cannot stop spending money in a casino. Most don’t consider other styles of gambling such as lottery, bingo, or other means which may cause financial and/or emotional burden, but still allow a person to function in society. I highly recommend doing at least a brief screening during intake. It is also imperative that the provider give a detailed definition of gambling.For a provider that is just learning about problem gambling, I suggest having the conversation. Asking the right questions and working on understanding the person’s situation. In most cases, a provider may be working with an individual that sought treatment due to other presenting issues. The gambling may or may not be a primary condition. Having the conversation, will help decipher further treatment.

What would be a recommendation to share with clinical supervisors or counselor educators in their work to educate new clinicians?As previously stated, I feel that problem gambling has really gone under the radar in mental health. Now that it has become its own individualized diagnosis in the DSM-V, I hope that education will increase. Therefore, my initial recommendation for clinical supervisors and counselor educators would be to seek out information on problem gambling. My training was provided by The Maryland Center of Excellence on Problem Gambling (http://www.mdproblemgambling.com/). They provide free as well as online training. The videos currently posted are a great introductory for problem gambling as well as how to assess for an addiction. I believe it is important for supervisors and educator to encourage new clinicians to keep problem gambling in mind. It is an issue that most individuals don’t initially divulge while seeking treatment. Some people start therapy due to other presenting issues (depression, anxiety, addiction, etc.) and may feel that their gambling is not an important factor or that the benefits of gambling may help with said presenting issues and therefore they may fear the clinician classifying it as a problem. This leads me back to talking with new clinicians about having the conversation. It is important to remain neutral and take a non-judgmental approach in order for the Client to feel comfortable talking about gambling. ​What would you like to share with a person who feels they experience problem gambling and has a desire to stop, or a family member of a person who experiences gambling disorder/addiction who is seeking help?As always, have the conversation. One of the most important things that might be overlooked is acknowledging that the individual is repeating a pattern for a reason. If a person suspects a gambling problem, it is key to understand the benefits of this behavior as well as the cost. I like to focus on what a person CAN do rather than what they can’t. This all begins with having the conversation and talking about an individual’s strengths. These are the tools that will help a person to develop a plan for managing problems.

Autumn 2017

Lakesha Roney, LPC

​Bio:Lakesha Roney is the Clinical Coordinator at Health Brigade (formerly Fan Free clinic) located in Richmond Virginia and she is the owner of Inner Self Counseling LLC since 2007 also located in Richmond, VA. Ms. Roney is a Licensed Professional Counselor who provides supervision to residents in counseling as well as being a doctoral candidate at Argosy University pursuing her Doctorate in Education Counseling Psychology.Despite her busy schedule and many responsibilities, Ms. Roney made time to speak about gambling addiction, treatment modalities, and perspectives as a clinical supervisor and treatment provider.

When asked what Ms. Roney thinks about the addition of gambling to addiction disorder in the DSM 5 she did not pause as she said, “It’s about time considering gambling’s effect on brain and it’s similarity to brain activity with stimulant use”.

Perception and experience working with persons having gambling addiction:“I enjoy working with individuals having addictive disorders and truly enjoying observing a person’s progress during intervention”. Psychoeducation was presented as the first step in treatment specific to comorbidity (quite common for those with gambling addiction) and addiction transfer, which Ms. Roney, tied together the addiction transfer of alcohol or drugs onto gambling behavior. She relayed that persons benefit from psychoeducation about the addicted brain in addition to the stimulus response involved in gambling. For treatment options, Cognitive Behavioral Therapy, Rational Emotive Therapy, and Relapse Prevention are three modalities that are structured and evidenced-based modalities that Ms. Roney utilizes in her work; they are “applicable and culturally sensitive…compare someone with a lower SES to someone considered middle class. The modalities are applicable to both”.

Clinical Supervisors:“Train and develop new professionals to understand evidence-based interventions, and offer proper supervision to those persons treating persons with addiction”. She encourages supervisors to educate supervisees about balancing transference and countertransference as “it happens often with addiction”.

Gamblers/clients:“What would you say if a gambler says voices fear of failure in recovery?”“I would start with psychoeducation and talk about cognitive distortions and then focus on strength-based. RELAPSE IS A PART OF RECOVERY. There is a cycle of addiction and guilt is part of that cycle, and then, let’s talk about coping skills for stressors and triggers.”

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